Physical Therapy for Common Running Injuries

Running has numerous benefits, including increased cardiovascular fitness and stronger muscles and joints. However, running injuries are a fairly common occurrence due to the repetitive stress that the act of running can place on certain joints and muscle groups. Physical therapists can help runners manage common injuries like runner’s knee and plantar fasciitis with personalized treatment that includes pain management, exercise rehabilitation, manual therapy, and body mechanic instruction.

Common Running Injuries

While running has many health benefits, running does place repetitive stress on certain joints and muscle groups, particularly the knee, hip, foot, and shin. Up to 60% of runners have or will experience an injury severe enough to sideline them from running for a few weeks or even months. Running injuries are acute or chronic. An acute injury is a broken bone or an ankle sprain due to a sudden impact or fall. A chronic injury occurs due to overuse in which force is repeatedly applied to a joint or muscle over a prolonged period of time, causing pain, inflammation, and injury.

 Factors that contribute to chronic running injuries include the terrain run upon, running shoe conditions, foot anatomy, overtraining, poor running form, increasing weekly mileage too quickly or intensity of workout too quickly, and decreased strength or flexibility. Overtraining is the leading cause of most overuse injuries.

Six of the most common chronic running injuries include:

• Plantar Fasciitis: Plantar fasciitis is the most common running injury to the foot, affecting 15% of runners. Plantar fasciitis is an overuse injury to the plantar fascia of the foot, causing small tears and inflammation of the tendons that connect the heel to the ball of the foot. It is common to feel pain at the start of the run or to have the pain subside during the run and recur later.  

• Achilles Tendinitis: Achilles tendinitis comprises 11% of runner injuries. The Achilles tendon connects the two calf muscles to the back of the heel. When the calf muscles contract, the Achilles tendon pulls on the heel, allowing the heel to rise, which is critical in order to run or walk. However, the Achilles tendon is particularly vulnerable to injury due to limited blood supply and the high tension placed on the tendon when running. Achilles tendinitis involves tightening and irritation of the Achilles tendon and is often caused by weak calf muscles in runners. A runner may experience pain, stiffness, and tenderness along the heel that increases when running

• Runner’s Knee: Runner’s knee, or patellofemoral pain syndrome (PFPS) is very common. Forty percent of running injuries involve the knee. The kneecap sits in a groove at the end of the femur, so that when the knee is bent, the kneecap glides up and down in the groove.  If the kneecap does not glide properly, pain can develop. With this condition, the runner experiences pain at the front of the knee and under and around the kneecap. It commonly develops after a sudden increase and intensity in training.  The knee pain is exacerbated by squatting, going up and down stairs, sitting, and standing for long periods of time.

• Shin Splints: A shin splint is an inflammatory condition of the shinbone that causes tenderness in the bones and muscles of the lower leg and small tears in the muscles surrounding the shinbone. Shin splints occur due to repetitive force on the shinbone and muscles in runners that suddenly increased the intensity and frequency of their runs or if the runner has begun running after extended time off.

• IT Band Syndrome: The IT Band is a fibrous band of connective tissue that connects the outside of the hip to the outside of the knee. It supports hip movement and helps to stabilize the knee. IT Band syndrome can become inflamed, leading to swelling and pain on the outside of the knee, often due to a sudden increase in the intensity and frequency of their runs. The runner may experience increased pain on slower runs or when running hills or going up or down stairs.

• Hip Tendinitis: Hip tendinitis involves the overuse and irritation of a tendon in the hip. When hip muscles are overused and strained from the repetitive force of running, the tendon can become inflamed and result in pain, tenderness, and mild swelling in the hip. Hip tendinitis can limit your hip mobility and proper running gait. 

Physical Therapy Treatment for Running Injuries

Physical therapists help runners prevent and manage these common running-related injuries with a customized treatment plan, tailored to the specific injury. Through pain management, exercise rehabilitation, manual therapy, and running mechanics instruction, the therapist helps the runner improve mobility, strengthen weak or imbalanced muscle groups, recover from injury safely, and ensure good body mechanics going forward.

Physical therapy treatment for these common running injuries include:

• Gait training and running mechanic instruction

• Modification of training program to help runner increase activity while lessening stress on and building strength in the affected area (such as with shin splints)

• Use of cross-training exercise to condition muscles without placing additional stress on the affected area, such as through a stationary bike or aquatic therapy

• Stretching exercises of the affected muscle groups and joints, e.g. stretching of the ankle and plantar fascia in plantar fasciitis or of the Achilles tendon to help to heal without shortening the tendon

• Strengthening exercises of the lower extremity, including hip, knee, ankle, and foot

  • For PFPS, targeted strengthening is done to the hip and knee muscles, hamstrings, and quadriceps as well as coordination training to retrain hip and knee movement patterns

  • Core strengthening to strengthen trunk muscles to support overall body movement and take pressure off hip and knee joints

• Use of ice and heat to manage pain

• Dry needling of leg muscles that are tight to release trigger points in those muscles, which may be causing pain and altering gait and movement

• Use of foot orthotics for plantar fasciitis and PFPS

• Manual therapy: soft-tissue and joint mobilization exercises to improve range of motion and improve pliability of the plantar fascia in plantar fasciitis

To prevent running injuries in the future:

• have proper running form to reduce stress on your joints and muscles

• engage in pre-and post-run stretching

• cross-train to strengthen your muscles and reduce stress on your joints

• gradually increase your run mileage and the intensity of your workouts

• be properly fitted for running shoes and replace your running shoes every 300 to 500 miles